Provider Demographics
NPI:1639622830
Name:WALLS, SARA (LCSW)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:
Last Name:WALLS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5205 BROADWAY ST # 775
Mailing Address - Street 2:
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77581-3942
Mailing Address - Country:US
Mailing Address - Phone:281-747-6034
Mailing Address - Fax:
Practice Address - Street 1:307 S FRIENDSWOOD DR STE B3
Practice Address - Street 2:
Practice Address - City:FRIENDSWOOD
Practice Address - State:TX
Practice Address - Zip Code:77546-3950
Practice Address - Country:US
Practice Address - Phone:281-747-6034
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-25
Last Update Date:2023-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX62674104100000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker